Endoscopic implant system and method
Disclosed is a system for endoscopically implanting a medical implant, including an anchor, within a body cavity such as adjacent the gastroesophageal junction in a human stomach. The system includes one or more anchors positionable within one or more openings formed in tissue within the body cavity, such as cutouts formed in plicated body tissue. Tools are disclosed for positioning the anchors within the openings, and for coupling a food restrictor to the anchors.
Latest Boston Scientific Scimed, Inc. Patents:
This application is a continuation of U.S. application Ser. No. 13/764,707, filed Feb. 11, 2013, now U.S. Pat. No. 9,456,825, which is a divisional of U.S. application Ser. No. 12/175,242, filed Jul. 17, 2008, (abandoned), which claims the benefit of priority of U.S. Provisional Application No. 61/042,862, filed Apr. 7, 2008, and U.S. Provisional Application No. 60/950,584, filed Jul. 18, 2007. The entirety of each of the above-referenced applications is incorporated herein by reference.
TECHNICAL FIELD OF THE INVENTIONThe present invention relates to the field of systems for use in endoscopically implanting devices within the gastrointestinal system.
BACKGROUNDAn anatomical view of a human stomach S and associated features is shown in
Stomach S includes a fundus F at its proximal end and an antrum A at its distal end. Antrum A feeds into the pylorus P which attaches to the duodenum D, the proximal region of the small intestine. Within the pylorus P is a sphincter that prevents backflow of food from the duodenum D into the stomach. The middle region of the small intestine, positioned distally of the duodenum D, is the jejunum J.
Several prior applications, including U.S. Publication No. US 2007/0276432 having a priority date of Oct. 8, 2004 and U.S. Publication No. US 2008/0065122, filed May 23, 2006 describe methods according to which medical implants are coupled to tissue structures, such as plications or folds, formed within the stomach. Examples of methods and devices for forming such tissue structures are described in U.S. Publication No. US 2007/0219571 (entitled ENDOSCOPIC PLICATION DEVICES AND METHOD), filed Oct. 3, 2006, U.S. application Ser. No. 11/900,757 (entitled ENDOSCOPIC PLICATION DEVICE AND METHOD), filed Sep. 13, 2007, and U.S. application Ser. No. 12/050,169 (entitled ENDOSCOPIC STAPLING DEVICES AND METHODS), filed Mar. 18, 2008. Each of the referenced publications and applications is incorporated herein by reference.
As disclosed in these prior applications, more robust and long lasting coupling between the implant and the surrounding stomach wall tissue is achieved when the plications/folds are formed by retaining regions of serosal tissue (i.e., the tissue on the exterior surface of the stomach) in contact with one another. Over time, adhesions form between the opposed serosal layers. These adhesions help to create strong bonds that can facilitate retention of the plication/fold over extended durations, despite the forces imparted on them by stomach movement and implanted devices
Several of the disclosed methods for forming tissue plications include a step in which a hole or cut is formed in the plication, using the plication device or other devices. An example of this type of plication is shown in
An anchor hand-off 16 delivers the anchors into the stomach, and anchor graspers 18 (one shown) are used to position the anchors within the tissue openings and also to guide the restrictor 14 to the implanted anchors. A restrictor guide 20 is provided for advancing the restrictor into position in the stomach. An endogastric overtube 22 is provided for establishing a working channel between the mouth and the stomach. Other tools shown elsewhere in the drawings, such as a multi-lumen guide 24 (
Anchor
One embodiment of an anchor 12 is shown in
Referring to
Head 32 includes a ring 34 and a plurality of struts 36 coupling the ring 34 to the stem 30, and an elongate loop 38 extending from the ring 34. The anchor is elastically deformable to an elongated shape (see
Referring to the top view of the anchor 12 shown in
Referring to
Referring again to
Anchor Hand-Off Tool
Anchor hand-off 16 is an instrument used to deliver individual anchors to the implantation site, and to hand-off each anchor to an anchor grasper which pulls the anchor through an opening in a plication.
Referring to
In one embodiment, the anchor hand-off 16 has a horseshoe shaped form with an opening 45 that narrows to form a constriction 47. The stretchable nature of the anchor stem 30 allows it to be squeezed through the constriction 47 and thus held in place by friction. See
Shaft 46 is slidably disposed in an articulating guide 49 that will articulate in response to actuation using pull wires or other means known to those skilled in the art. The articulating guide 26 may be one with video capability, for example it might be an articulating endoscope. In one embodiment, wire element 48 is detachable from the shaft 46 of the anchor hand-off 16 to allow shaft 48 to pass through a small diameter tool channel in the articulating guide 26. Once the distal end of the shaft 46 reaches the distal end of the guide 26, the wire element 48 is coupled to the shaft 46.
Furthermore, the anchor hand-off tool 16 may be designed to hold the anchor behind (or axially off-set from) the distal tip of the articulating guide 26 with video capability. This facilitates greater visibility at the target site/plication by positioning the held anchor out of the endoscope's field of view as shown in
Anchor Grasper Tool
Anchor grasper 18 is designed to couple to or engage a portion of the head 32 of an anchor 12. It is used to pull the anchor 12 through an opening in a plication, and to pull the anchor through a corresponding opening in a restrictor that is to be implanted. The anchor grasper 18 may have a variety of designs that allow these functions to be carried out. One such design is shown in
A closure tube 56 is longitudinally slidable over the hook and gate to lock them in the closed position, thus preventing them from separating. The collar and associated features are proportioned to ensure that when the grasping element 50 is to be locked, bending of the shaft of the anchor grasper 18 does not cause the closure tube 56 to slide into a position that will release the grasping element 50 from the locked position.
Referring to
Hypotube 64 is slidably and rotatably disposed within outer tubing 60, and includes a pin 66 disposed within the slot 62. Hypotube 64 is mounted to a tapered handle 68. A cable 70 has a distal end coupled to the grasping element 50 and a proximal end mounted to the handle 68.
To close and lock the grasping element, the outer tube 60 is advanced distally relative to the handle 68. Advancement of the outer tube 60 pushes the coil 58 and thus the closure tube 56 in a distal position until the closure tube 56 moves the grasping element 50 to the closed position shown in
Restrictor
The restrictor is an implant designed to slow the passage of food from the esophagus into the stomach. The illustrated embodiments, the restrictor is positioned in the stomach such that food enters the restrictor through a proximal opening and exits the restrictor through a distal opening. The restrictor and/or openings are proportioned to slow the rate at which food can move into or through the restrictor, and/or from the restrictor into the rest of the stomach.
A preferred restrictor is proportioned to be coupled to anchors that have been coupled to plications in the gastroesophageal junction region of the proximal stomach. In a preferred design, the restrictor 14 includes features that minimize pulling against the anchors when the restrictor encounters stress as a result of food moving through the restrictor and/or movement of the stomach. Minimizing pulling at the anchors is beneficial for minimizing stress on the stomach wall tissue coupled to the anchors. In general, the restrictor 14 is designed to have compliance between the anchor points (i.e., the points at which the implant is coupled to the tissue directly or using the anchors). This compliance may be achieved using the geometry of the restrictor 14 and/or using restrictor materials selected to give compliance between anchor points.
In a first embodiment shown in
Anchor openings 80 are positioned between the radial peaks 82. These openings may be positioned in the portion of the wall that is at the most radially inward position as on the restrictor 14a of
Openings 80 may be surrounded by reinforced sections 92 formed using thicker regions of silicone, or a stronger material embedded in or attached to the silicone. Additional reinforcements such as ribs 94a, 94b may extend from the openings 80 towards the orifice 86 and/or from the proximal peaks 78 towards the orifice 86 and may be formed using similar techniques.
The edge of the wall defining the orifice 86 preferably includes folds or undulations 96, allowing the orifice to be compliant as well. In addition, small holes 98 are arranged around the orifice to allow the restrictor 14 to be coupled to the restrictor guide used to deliver the restrictor into the stomach.
An alternative restrictor 14b shown in
Yet another alternative restrictor 14c (
An additional restrictor 14d is molded out of a combination of high and low compliance material (such as 50 shore A plus 40 shore 00 silicones) in different areas of the restrictor to achieve optimal performance. A rib structure 94c (see
Restrictor Guide Tool
Restrictor guide 20 generally includes a tubular shaft 101, a distal portion comprising a coupling element/mount 102 and a proximal portion 104.
In a preferred restrictor guide, the mount 102 is designed to support the restrictor 14 during delivery of the restrictor into the stomach and coupling of the restrictor 12 to the stomach wall (directly or using anchors or other means as disclosed herein). In the illustrated embodiment, mount 102 includes a collar 103 on the distal end of the shaft 101. A pair of tubes 112 extend distally between the collar 103 and a ring 107. Ring 107 includes a plurality of distally extending pins 106 and a central opening 109. A tube 111 is positioned co-axially with the opening 109. A distal cap 108 is mounted to the distal end of the tube 111. Cap 108 includes an opening positioned in alignment with the opening of the ring 107 and the lumen of the tube 111. Bores 110 in the cap are positioned so that proximal advancement of the cap 108 relative to the ring 107 causes pins 106 to enter the bores 110.
Referring to
Drive rods 112a (
Proximal portion 104 of the restrictor guide 20 is a multi-lumen guide having a central lumen 114 through which the tubular shaft 101 extends, and a plurality of peripheral lumens 116 arranged around the central lumen. The peripheral lumens 116 are proportioned to accommodate the anchor graspers 18. Each of the peripheral lumens 116 has a proximal port fitted with a seal (which may be, for example, a duck bill seal) that will seal around the shaft of a grasper 18 positioned in the lumen, and that will self-seal when the grasper 18 is removed from the lumen.
Exemplary Procedure
Use of the system 10 to implant a restrictor 14 will next be described. According to one embodiment, the method is performed following an initial procedure in which a plurality of plications P having cutouts or other openings C are formed. In another embodiment, after each plication is formed, an anchor 12 is implanted in that plication's opening for the dual purpose of marking the location of the plication as well as ensuring that the opening does not close in the natural healing process of the tissue. The anchor implantation procedure may immediately precede restrictor implantation, or may instead be performed in advance of the restrictor implantation procedure to allow reinforcement of the plications through the body's healing process.
In the initial phase of the restrictor implantation procedure, anchors 12 are positioned in the openings of the plications P. Referring to
Outside the body, an anchor hand-off 16 is passed through a tool channel of an endoscope 26 such that the anchor engaging wire 48 extends from the endoscope lumen. With the engaging wire in this position, an anchor 12 is coupled to the engaging wire 48, and the endoscope 26, anchor hand-off 16, and anchor 12 are together passed through the central lumen 24a of the multi-lumen guide tube 24 and into the stomach as shown in
Next, an articulating guide 25 is advanced through a peripheral lumen 24b of the multi-lumen guide tube 24 and into the stomach. An anchor grasper 18 is positioned in the lumen of the guide 25. Under visualization using endoscope 26 (with anchor hand-off 18 retracted so that the anchor is out of view), guide 25 is articulated to orient the grasper 18 towards the opening C in the plication, and the grasper 18 is then advanced through the opening as also shown in
Referring to
The endoscope 26 and anchor hand-off 16 are withdrawn from the guide tube 24 along with the multiple lumen guide and articulating guide. After another plication is created, the process is repeated for each anchor that is to be implanted. See
As each anchor is implanted, its corresponding anchor grasper is preferably left coupled to the ring of the anchor, although it may instead be withdrawn from the body. At the end of the anchor-positioning phase of the procedure, each anchor is positioned extending through a plication opening (
If the anchor graspers 18 are not left in place following implantation of the individual anchors 12, the graspers 18 are re-coupled to the anchors prior to the restrictor-positioning phase. Specifically, each of the graspers 18 is reintroduced into the stomach and endoscopically guided by its corresponding articulated guide 25 into engagement with the head 32 of one of the anchors. As discussed in the Anchors section above, orientation of the loop 38 to extend in a direction opposite to the asymmetrical base 28 helps to orient the loop 38 centrally within the stomach so that the loops 38 may be more easily seen and engaged by the graspers 18.
The restrictor-positioning phase of implantation begins with each anchor that is to be coupled to the restrictor having a separate anchor grasper 18 coupled to it. If the multi-lumen guide 24 is still in use at this point, with individual ones of the graspers 18 in the peripheral lumen 24b, the guide 24 is withdrawn from the endogastric tube 22 and removed from the handles of the anchor graspers. The tapered proximal ends of the anchor graspers 18 allow the lumens 24b of the guide 24 to pass easily over them. Before the multiple lumen guide is completely removed from the endogastric tube 22, the anchor grasper tool shafts are locked into a tool organizer 130 at the proximal end of the endogastric tube 22 as shown in
The restrictor 14 is prepared for implantation by threading anchor openings 80 in the restrictor over the tapered proximal ends of the anchor graspers 18, which at this point are still extending out of the endogastric tube 22.
Next, the restrictor guide 20 is advanced over the tapered proximal ends of the anchor graspers 18, which are still extending out of the endogastric tube 22. The restrictor guide 20 is positioned so that each of its peripheral lumens 116 advances over a separate one of the anchor graspers 18.
In a final step, the anchors 12 are pulled through the anchor openings 80 to couple the restrictor 14 to the anchors 12. In this step, distally-oriented pressure is applied to the restrictor guide 20 while the anchor graspers 18 are one-by-one pulled proximally, causing the anchors 12 to elongate sufficiently to pass through the openings 90. Coupling between each anchor and its corresponding opening 80 is confirmed visually and/or by tactile feedback reflecting the “pop” of the anchor moving through the opening 80. Once the restrictor 14 has been coupled to the anchors 12, the cap 108 of the restrictor guide 20 is advanced distally to release the restrictor as described in the Restrictor Guide section above. The anchor graspers 18 are unlocked and separated from the anchors. The restrictor guide 20, anchor graspers 18, guides, etc. are withdrawn from the body, leaving the restrictor 14 and anchors 12 in place as shown in
The system of
Use of one such tool is generally illustrated in
Although the disclosed system has been described in the context of implanting a restrictor implants implantable in the stomach for limiting limit intake of food by the patient, the systems and methods may be used to implant other types of implants for a variety of purposes. These implants include, but are not limited to obstructive gastric implants that obstruct flow of food into the stomach, gastric space occupiers for limiting effective stomach volume, prosthetic valves for the treatment of gastro-esophageal reflux disease, gastric stimulators, pH monitors and drug eluting devices that release drugs, biologics or cells into the stomach or elsewhere in the GI tract. Such drug eluting devices might include those which release leptin (a hormone which creates feelings of satiety), Ghrelin (a hormone which creates feelings of hunger), octreotide (which reduces Ghrelin levels and thus reduces hunger), Insulin, chemotherapeutic agents, natural biologics (e.g., growth factor, cytokines) which aid in post surgery trauma, ulcers, lacerations, etc. Still other implants might be of a type which might provide a platform to which specific cell types can adhere, grow and provide biologically-active gene products to the GI tract, and/or a platform for radiation sources that can provide a local source of radiation for therapeutic purposes, or provide a platform whereby diagnostic ligands are immobilized and used to sample the GI tract for evidence of specific normal or pathological conditions, or provide an anchor point for imaging the GI tract via cameras and other image collecting devices. Additionally, the disclosed anchors and restrictors are shown positioned and anchored near the gastro-esophageal junction region of the proximal stomach, but may be positioned and/or anchored elsewhere in the stomach or GI system.
It should also be recognized that a number of variations of the above-identified embodiments will be obvious to one of ordinary skill in the art in view of the foregoing description. Accordingly, the invention is not to be limited by those specific embodiments and methods of the present invention shown and described herein. Rather, the scope of the invention is to be defined by the following claims and their equivalents.
Any and all patents and patent applications referred to herein, including for purposes of priority, are incorporated herein by reference.
Claims
1. An implant for placement within a patient's gastrointestinal system, comprising:
- a head, a base, and a stem extending between the head and the base, wherein each of the head and the base has a diameter greater than a diameter of the stem, the head is elastically deformable, and the base has a first edge with a first curvature and a second edge with a second curvature different than the first curvature;
- wherein the head includes a ring, a plurality of struts coupling the ring to the stem, and a loop extending from the ring, and the ring has an undulating surface.
2. The implant of claim 1, wherein the head includes a plurality of apertures, and the base is a continuous material without apertures.
3. The implant of claim 1, wherein the base includes reinforcing ribs extending from the stem to an edge of the base.
4. The implant of claim 1, wherein the base is asymmetrical relative to a longitudinal axis of the stem.
5. The implant of claim 1, wherein the head includes a higher durometer material than the stem and the base.
6. The implant of claim 1, wherein the implant is configured to be positioned in a hole of a tissue plication.
7. The implant of claim 1, wherein the base has an outer diameter that is larger than an outer diameter of the head.
8. The implant of claim 1, wherein the head is deformable between a first, natural position and a second, deformed position, wherein, in the second position, the head has a length in a direction parallel to a longitudinal axis of the stem that is greater than a length of the head in the direction parallel to the longitudinal axis of the stem in the first position.
9. The implant of claim 8, wherein, when the head is in the second, deformed position, the head is lengthened in a direction away from the base, as compared to the head in the first, natural position.
10. The implant of claim 1, wherein the head includes a plurality of apertures defined by the ring and the plurality of struts.
1408865 | March 1922 | Cowell |
3663965 | May 1972 | Lee et al. |
4007743 | February 15, 1977 | Blake |
4134405 | January 16, 1979 | Smit |
4207890 | June 17, 1980 | Mamajek et al. |
4246893 | January 27, 1981 | Berson |
4315509 | February 16, 1982 | Smit |
4331277 | May 25, 1982 | Green |
4403604 | September 13, 1983 | Wilkinson et al. |
4416267 | November 22, 1983 | Garren et al. |
4417360 | November 29, 1983 | Moasser |
4441215 | April 10, 1984 | Kaster |
4467804 | August 28, 1984 | Hardy et al. |
4485805 | December 4, 1984 | Foster, Jr. |
4501264 | February 26, 1985 | Rockey |
4607618 | August 26, 1986 | Angelchik |
4617932 | October 21, 1986 | Kornberg |
4641653 | February 10, 1987 | Rockey |
4643184 | February 17, 1987 | Mobin-Uddin |
4648383 | March 10, 1987 | Angelchik |
4694827 | September 22, 1987 | Weiner et al. |
4723547 | February 9, 1988 | Kullas et al. |
4747849 | May 31, 1988 | Galtier |
4846836 | July 11, 1989 | Reich |
4848367 | July 18, 1989 | Avant et al. |
4899747 | February 13, 1990 | Garren et al. |
4925446 | May 15, 1990 | Garay et al. |
4946440 | August 7, 1990 | Hall |
4969896 | November 13, 1990 | Shors |
4997084 | March 5, 1991 | Opie et al. |
5006106 | April 9, 1991 | Angelchik |
5037021 | August 6, 1991 | Mills et al. |
5061275 | October 29, 1991 | Wallsten et al. |
5084061 | January 28, 1992 | Gau et al. |
5088979 | February 18, 1992 | Fillipi et al. |
5163952 | November 17, 1992 | Froix |
5192301 | March 9, 1993 | Kamiya |
5211658 | May 18, 1993 | Clouse |
5234454 | August 10, 1993 | Bangs |
5246456 | September 21, 1993 | Wilkinson |
5259399 | November 9, 1993 | Brown |
5263629 | November 23, 1993 | Trumbull et al. |
5290217 | March 1, 1994 | Campos |
5306300 | April 26, 1994 | Berry |
5314473 | May 24, 1994 | Godin |
5327914 | July 12, 1994 | Shlain |
5342393 | August 30, 1994 | Stack |
5345949 | September 13, 1994 | Shain |
5350399 | September 27, 1994 | Erlebacher |
5355897 | October 18, 1994 | Pietrafitta et al. |
5401241 | March 28, 1995 | Delany |
5403326 | April 4, 1995 | Harrison et al. |
5405377 | April 11, 1995 | Cragg |
5431673 | July 11, 1995 | Summers et al. |
5486187 | January 23, 1996 | Schneck |
5514176 | May 7, 1996 | Bosley |
5535935 | July 16, 1996 | Vidal et al. |
5542949 | August 6, 1996 | Yoon |
5562239 | October 8, 1996 | Boiarski et al. |
5571116 | November 5, 1996 | Bolanos et al. |
5577654 | November 26, 1996 | Bishop |
5593434 | January 14, 1997 | Williams |
5597107 | January 28, 1997 | Knodel et al. |
5609624 | March 11, 1997 | Kalis |
5628786 | May 13, 1997 | Banas |
5630539 | May 20, 1997 | Plyley et al. |
5647526 | July 15, 1997 | Green et al. |
5653743 | August 5, 1997 | Martin |
5662713 | September 2, 1997 | Anderson et al. |
5673841 | October 7, 1997 | Schulze et al. |
5674241 | October 7, 1997 | Bley et al. |
5706998 | January 13, 1998 | Plyley et al. |
5709657 | January 20, 1998 | Zimmon |
5720776 | February 24, 1998 | Chuter et al. |
5749918 | May 12, 1998 | Hogendijk et al. |
5762255 | June 9, 1998 | Chrisman et al. |
5771903 | June 30, 1998 | Jakobsson |
5785684 | July 28, 1998 | Zimmon |
5792119 | August 11, 1998 | Marx |
5820584 | October 13, 1998 | Crabb |
5839639 | November 24, 1998 | Sauer et al. |
5848964 | December 15, 1998 | Samuels |
5855311 | January 5, 1999 | Hamblin et al. |
5855601 | January 5, 1999 | Bessler et al. |
5856445 | January 5, 1999 | Korsmeyer |
5861036 | January 19, 1999 | Godin |
5868141 | February 9, 1999 | Elias |
5887594 | March 30, 1999 | LoCicero, III |
5897562 | April 27, 1999 | Bolanos et al. |
5910144 | June 8, 1999 | Hayashi |
5922019 | July 13, 1999 | Hankh et al. |
5947983 | September 7, 1999 | Solar et al. |
5993473 | November 30, 1999 | Chan et al. |
5993483 | November 30, 1999 | Gianotti |
6016848 | January 25, 2000 | Egres |
6051015 | April 18, 2000 | Maahs |
6086600 | July 11, 2000 | Kortenback |
6098629 | August 8, 2000 | Johnson et al. |
6102922 | August 15, 2000 | Jakobbson et al. |
6113609 | September 5, 2000 | Adams |
6120534 | September 19, 2000 | Ruiz |
6146416 | November 14, 2000 | Andersen et al. |
6159146 | December 12, 2000 | El Gazayerli |
6159238 | December 12, 2000 | Killion et al. |
6174322 | January 16, 2001 | Schneidt |
6197022 | March 6, 2001 | Baker |
6206930 | March 27, 2001 | Burg et al. |
6245088 | June 12, 2001 | Lowery |
6251132 | June 26, 2001 | Ravenscroft et al. |
6254642 | July 3, 2001 | Taylor |
6258120 | July 10, 2001 | McKenzie et al. |
6264700 | July 24, 2001 | Kilcoyne et al. |
6287334 | September 11, 2001 | Moll et al. |
6302917 | October 16, 2001 | Dua et al. |
6358197 | March 19, 2002 | Silverman |
6416522 | July 9, 2002 | Strecker |
6425916 | July 30, 2002 | Garrison et al. |
6454785 | September 24, 2002 | De Hoyos Garza |
6460543 | October 8, 2002 | Forsell |
6461366 | October 8, 2002 | Seguin |
6494888 | December 17, 2002 | Laufer et al. |
6494895 | December 17, 2002 | Addis |
6503264 | January 7, 2003 | Birk |
6506196 | January 14, 2003 | Laufer et al. |
6527784 | March 4, 2003 | Adams et al. |
6540789 | April 1, 2003 | Silverman et al. |
6544291 | April 8, 2003 | Taylor |
6547801 | April 15, 2003 | Dargent et al. |
6551303 | April 22, 2003 | Van Tassel |
6558400 | May 6, 2003 | Deem et al. |
6558429 | May 6, 2003 | Taylor et al. |
6572627 | June 3, 2003 | Gabbay |
6572629 | June 3, 2003 | Kalloo |
6575896 | June 10, 2003 | Silverman |
6592596 | July 15, 2003 | Geitz |
6596023 | July 22, 2003 | Nunez et al. |
6607555 | August 19, 2003 | Patterson et al. |
6627206 | September 30, 2003 | Lloyd |
6632227 | October 14, 2003 | Adams |
6663639 | December 16, 2003 | Laufer et al. |
6675809 | January 13, 2004 | Stack et al. |
6692507 | February 17, 2004 | Pugsley et al. |
6733512 | May 11, 2004 | McGhan |
6736828 | May 18, 2004 | Adams et al. |
6740098 | May 25, 2004 | Abrams et al. |
6740121 | May 25, 2004 | Geitz |
6746460 | June 8, 2004 | Gannoe et al. |
6755869 | June 29, 2004 | Geitz |
6764518 | July 20, 2004 | Godin |
6773440 | August 10, 2004 | Gannoe et al. |
6773441 | August 10, 2004 | Laufer et al. |
6790214 | September 14, 2004 | Kraemer et al. |
6790237 | September 14, 2004 | Stinson |
6821285 | November 23, 2004 | Laufer et al. |
6835200 | December 28, 2004 | Laufer et al. |
6845776 | January 25, 2005 | Stack et al. |
6916332 | July 12, 2005 | Adams |
6932838 | August 23, 2005 | Schwartz et al. |
6960224 | November 1, 2005 | Marino |
6960233 | November 1, 2005 | Berg et al. |
6966875 | November 22, 2005 | Longboardi |
6981978 | January 3, 2006 | Gannoe |
6981980 | January 3, 2006 | Sampson et al. |
6994715 | February 7, 2006 | Gannoe et al. |
7011094 | March 14, 2006 | Rapacki et al. |
7020531 | March 28, 2006 | Colliou et al. |
7025791 | April 11, 2006 | Levine et al. |
7033373 | April 25, 2006 | de la Torre et al. |
7033384 | April 25, 2006 | Gannoe et al. |
7037344 | May 2, 2006 | Kagan et al. |
7056305 | June 6, 2006 | Garza |
7066945 | June 27, 2006 | Hashiba et al. |
7074229 | July 11, 2006 | Adams et al. |
7083629 | August 1, 2006 | Weller et al. |
7083636 | August 1, 2006 | Kortenbach |
7090699 | August 15, 2006 | Geitz |
7097650 | August 29, 2006 | Weller et al. |
7097665 | August 29, 2006 | Stack et al. |
7111627 | September 26, 2006 | Stack et al. |
7112186 | September 26, 2006 | Shah |
7120498 | October 10, 2006 | Imran et al. |
7121283 | October 17, 2006 | Stack et al. |
7146984 | December 12, 2006 | Stack et al. |
7147140 | December 12, 2006 | Wukusick et al. |
7152607 | December 26, 2006 | Stack et al. |
7160312 | January 9, 2007 | Saadat et al. |
7172613 | February 6, 2007 | Wazne |
7175638 | February 13, 2007 | Gannoe et al. |
7175660 | February 13, 2007 | Cartledge et al. |
7182771 | February 27, 2007 | Houser |
7211114 | May 1, 2007 | Bessler et al. |
7214233 | May 8, 2007 | Gannoe et al. |
7220237 | May 22, 2007 | Gannoe et al. |
7220284 | May 22, 2007 | Kagan et al. |
7223277 | May 29, 2007 | DeLegge |
7229428 | June 12, 2007 | Gannoe et al. |
7229453 | June 12, 2007 | Anderson et al. |
7255675 | August 14, 2007 | Gertner et al. |
7261722 | August 28, 2007 | McGuckin, Jr. et al. |
7288101 | October 30, 2007 | Deem et al. |
7306614 | December 11, 2007 | Weller et al. |
7315509 | January 1, 2008 | Jeong et al. |
7316716 | January 8, 2008 | Egan |
7320696 | January 22, 2008 | Gazi et al. |
7326207 | February 5, 2008 | Edwards |
7335210 | February 26, 2008 | Smit |
7347863 | March 25, 2008 | Rothe et al. |
7347875 | March 25, 2008 | Levine et al. |
7354454 | April 8, 2008 | Stack et al. |
7399304 | July 15, 2008 | Gambale et al. |
7431725 | October 7, 2008 | Stack et al. |
7571729 | August 11, 2009 | Saadat et al. |
7674222 | March 9, 2010 | Nikolic |
7699863 | April 20, 2010 | Marco et al. |
7704268 | April 27, 2010 | Chanduszko |
7744627 | June 29, 2010 | Orban, III |
7753870 | July 13, 2010 | Demarais et al. |
7766861 | August 3, 2010 | Levine et al. |
7837669 | November 23, 2010 | Dann et al. |
7931661 | April 26, 2011 | Saadat et al. |
8020741 | September 20, 2011 | Cole et al. |
8277481 | October 2, 2012 | Kawaura |
20010011543 | August 9, 2001 | Forsell |
20010020189 | September 6, 2001 | Taylor |
20010020190 | September 6, 2001 | Taylor |
20010021796 | September 13, 2001 | Silverman et al. |
20010044595 | November 22, 2001 | Reydel et al. |
20020022851 | February 21, 2002 | Kalloo et al. |
20020055757 | May 9, 2002 | Torre et al. |
20020072761 | June 13, 2002 | Abrams et al. |
20020082621 | June 27, 2002 | Schurr et al. |
20020099439 | July 25, 2002 | Schwartz et al. |
20020183767 | December 5, 2002 | Adams et al. |
20020183768 | December 5, 2002 | Deem et al. |
20020183823 | December 5, 2002 | Pappu |
20030009236 | January 9, 2003 | Godin |
20030040804 | February 27, 2003 | Stack et al. |
20030040808 | February 27, 2003 | Stack et al. |
20030055455 | March 20, 2003 | Yang |
20030065340 | April 3, 2003 | Geitz |
20030065359 | April 3, 2003 | Weller et al. |
20030093108 | May 15, 2003 | Avellanet |
20030093117 | May 15, 2003 | Saadat |
20030109892 | June 12, 2003 | Deem et al. |
20030120289 | June 26, 2003 | McGuckin, Jr. et al. |
20030158569 | August 21, 2003 | Wazne |
20030191476 | October 9, 2003 | Smit |
20030199989 | October 23, 2003 | Stack et al. |
20030199990 | October 23, 2003 | Stack et al. |
20030199991 | October 23, 2003 | Stack et al. |
20030208209 | November 6, 2003 | Gambale et al. |
20030220657 | November 27, 2003 | Adams |
20030220660 | November 27, 2003 | Kortenbach et al. |
20030236536 | December 25, 2003 | Grigoryants et al. |
20040006351 | January 8, 2004 | Gannoe et al. |
20040024386 | February 5, 2004 | Deem et al. |
20040030347 | February 12, 2004 | Gannoe et al. |
20040044353 | March 4, 2004 | Gannoe |
20040044354 | March 4, 2004 | Gannoe et al. |
20040044357 | March 4, 2004 | Gannoe et al. |
20040044361 | March 4, 2004 | Frazier |
20040044364 | March 4, 2004 | DeVries |
20040059289 | March 25, 2004 | Garza et al. |
20040068276 | April 8, 2004 | Golden et al. |
20040082963 | April 29, 2004 | Gannoe et al. |
20040088023 | May 6, 2004 | Imran et al. |
20040092892 | May 13, 2004 | Kagan et al. |
20040092974 | May 13, 2004 | Gannoe et al. |
20040093091 | May 13, 2004 | Gannoe et al. |
20040098043 | May 20, 2004 | Trout |
20040107004 | June 3, 2004 | Levine et al. |
20040116949 | June 17, 2004 | Ewers et al. |
20040117031 | June 17, 2004 | Stack et al. |
20040122456 | June 24, 2004 | Saadat et al. |
20040138761 | July 15, 2004 | Stack et al. |
20040139761 | July 22, 2004 | Stack et al. |
20040143294 | July 22, 2004 | Corcoran |
20040143342 | July 22, 2004 | Stack et al. |
20040148034 | July 29, 2004 | Kagan et al. |
20040153167 | August 5, 2004 | Stack et al. |
20040158331 | August 12, 2004 | Stack et al. |
20040162568 | August 19, 2004 | Saadat et al. |
20040172141 | September 2, 2004 | Stack et al. |
20040172142 | September 2, 2004 | Stack et al. |
20040186502 | September 23, 2004 | Sampson et al. |
20040210243 | October 21, 2004 | Gannoe et al. |
20040215216 | October 28, 2004 | Gannoe et al. |
20040220682 | November 4, 2004 | Levine et al. |
20040225183 | November 11, 2004 | Michlitsch et al. |
20040225305 | November 11, 2004 | Ewers et al. |
20040236419 | November 25, 2004 | Milo |
20040243152 | December 2, 2004 | Taylor et al. |
20040243223 | December 2, 2004 | Kraemer et al. |
20040249367 | December 9, 2004 | Saadat et al. |
20040267378 | December 30, 2004 | Gazi et al. |
20050004430 | January 6, 2005 | Lee et al. |
20050004681 | January 6, 2005 | Stack et al. |
20050033326 | February 10, 2005 | Briganti |
20050033345 | February 10, 2005 | DeLegge |
20050049718 | March 3, 2005 | Dann et al. |
20050065547 | March 24, 2005 | Marino |
20050070957 | March 31, 2005 | Das |
20050075654 | April 7, 2005 | Kelleher |
20050080444 | April 14, 2005 | Kraemer et al. |
20050085787 | April 21, 2005 | Laufer et al. |
20050096673 | May 5, 2005 | Stack et al. |
20050096750 | May 5, 2005 | Kagan et al. |
20050119671 | June 2, 2005 | Reydel et al. |
20050149114 | July 7, 2005 | Cartledge et al. |
20050154252 | July 14, 2005 | Sharkey |
20050159769 | July 21, 2005 | Alverdy |
20050177181 | August 11, 2005 | Kagan et al. |
20050183732 | August 25, 2005 | Edwards |
20050192599 | September 1, 2005 | Demarais |
20050192615 | September 1, 2005 | Torre et al. |
20050203550 | September 15, 2005 | Laufer et al. |
20050216040 | September 29, 2005 | Gertner et al. |
20050216042 | September 29, 2005 | Gertner |
20050228504 | October 13, 2005 | Demarais et al. |
20050240279 | October 27, 2005 | Kagan et al. |
20050247320 | November 10, 2005 | Stack et al. |
20050250980 | November 10, 2005 | Swanstrom et al. |
20050251158 | November 10, 2005 | Sadat et al. |
20050251159 | November 10, 2005 | Ewers et al. |
20050251161 | November 10, 2005 | Saadat et al. |
20050251162 | November 10, 2005 | Rothe et al. |
20050251176 | November 10, 2005 | Swanstrom et al. |
20050251177 | November 10, 2005 | Saadat et al. |
20050256533 | November 17, 2005 | Roth et al. |
20050256587 | November 17, 2005 | Egan |
20050261712 | November 24, 2005 | Balbierz et al. |
20050267405 | December 1, 2005 | Shah |
20050267499 | December 1, 2005 | Stack et al. |
20050267524 | December 1, 2005 | Chanduszko |
20050267595 | December 1, 2005 | Chen et al. |
20050267596 | December 1, 2005 | Chen et al. |
20050273060 | December 8, 2005 | Levy et al. |
20050273135 | December 8, 2005 | Chanduszko |
20050283107 | December 22, 2005 | Kalanovic et al. |
20060014998 | January 19, 2006 | Sharkey |
20060015006 | January 19, 2006 | Laurence et al. |
20060020278 | January 26, 2006 | Burnett et al. |
20060058829 | March 16, 2006 | Sampson et al. |
20060100643 | May 11, 2006 | Laufer et al. |
20060106418 | May 18, 2006 | Seibold |
20060129094 | June 15, 2006 | Shah |
20060135971 | June 22, 2006 | Swanstrom et al. |
20060151568 | July 13, 2006 | Weller et al. |
20060155259 | July 13, 2006 | MacLay |
20060155311 | July 13, 2006 | Hashiba et al. |
20060157067 | July 20, 2006 | Saadat et al. |
20060178560 | August 10, 2006 | Saadat et al. |
20060178691 | August 10, 2006 | Binmoeller |
20060195139 | August 31, 2006 | Gertner |
20060253142 | November 9, 2006 | Bjerken |
20060271076 | November 30, 2006 | Weller et al. |
20060282095 | December 14, 2006 | Stokes et al. |
20060287734 | December 21, 2006 | Stack et al. |
20070010864 | January 11, 2007 | Dann et al. |
20070027548 | February 1, 2007 | Levine et al. |
20070032800 | February 8, 2007 | Ortiz et al. |
20070043384 | February 22, 2007 | Ortiz et al. |
20070055292 | March 8, 2007 | Ortiz et al. |
20070060932 | March 15, 2007 | Stack et al. |
20070149994 | June 28, 2007 | Sosnowski et al. |
20070175488 | August 2, 2007 | Cox et al. |
20070191870 | August 16, 2007 | Baker et al. |
20070191871 | August 16, 2007 | Baker et al. |
20070198074 | August 23, 2007 | Dann et al. |
20070219571 | September 20, 2007 | Balbierz et al. |
20070239284 | October 11, 2007 | Skerven et al. |
20070260327 | November 8, 2007 | Case et al. |
20070276428 | November 29, 2007 | Haller et al. |
20070276432 | November 29, 2007 | Stack et al. |
20080033574 | February 7, 2008 | Bessler et al. |
20080065122 | March 13, 2008 | Stack et al. |
20080116244 | May 22, 2008 | Rethy et al. |
20080190989 | August 14, 2008 | Crews et al. |
20080208355 | August 28, 2008 | Stack et al. |
20080294179 | November 27, 2008 | Balbierz et al. |
20080319471 | December 25, 2008 | Sosnowski et al. |
20090024143 | January 22, 2009 | Crews et al. |
20090030284 | January 29, 2009 | Cole et al. |
20090125040 | May 14, 2009 | Hambly et al. |
20090182424 | July 16, 2009 | Marco et al. |
680263 | July 1992 | CH |
8708978 | November 1987 | DE |
0 775 471 | May 1997 | EP |
1 492 478 | January 2005 | EP |
1 602 336 | December 2005 | EP |
2768324 | March 1999 | FR |
09-168597 | June 1997 | JP |
WO1991/01117 | February 1991 | WO |
WO1995/025468 | September 1995 | WO |
WO1997/47231 | December 1997 | WO |
WO2000/12027 | March 2000 | WO |
WO2000/32137 | June 2000 | WO |
WO2000/78227 | December 2000 | WO |
WO2001/45485 | June 2001 | WO |
WO2001/49359 | July 2001 | WO |
WO2001/66018 | September 2001 | WO |
WO2001/85034 | November 2001 | WO |
WO2001/89393 | November 2001 | WO |
WO2002/060328 | August 2002 | WO |
WO2003/017882 | March 2003 | WO |
2003/086246 | October 2003 | WO |
WO2003/086246 | October 2003 | WO |
WO2003/086247 | October 2003 | WO |
WO2003/090633 | November 2003 | WO |
WO2003/094784 | November 2003 | WO |
WO2003/094785 | November 2003 | WO |
WO2003/099137 | December 2003 | WO |
WO2004/019765 | March 2004 | WO |
WO2004/019787 | March 2004 | WO |
WO2004/032760 | April 2004 | WO |
WO2004/037064 | May 2004 | WO |
WO2004/041133 | May 2004 | WO |
WO2004/064680 | August 2004 | WO |
WO2004/064685 | August 2004 | WO |
WO2004/080336 | September 2004 | WO |
WO2004/110285 | December 2004 | WO |
WO2005/037152 | April 2005 | WO |
WO2005/074894 | August 2005 | WO |
WO2005/079673 | September 2005 | WO |
WO2005/096991 | October 2005 | WO |
WO2005/105003 | November 2005 | WO |
WO2006/016894 | February 2006 | WO |
2006/055365 | May 2006 | WO |
WO2006/055365 | May 2006 | WO |
WO2006/127593 | November 2006 | WO |
WO2007/041598 | April 2007 | WO |
WO2008/030403 | March 2008 | WO |
WO2008/033409 | March 2008 | WO |
WO2008/033474 | March 2008 | WO |
WO2008/141288 | November 2008 | WO |
WO2009/011881 | January 2009 | WO |
WO2009/011882 | January 2009 | WO |
- International Search Report from PCT Patent Application No. PCT/US2002/027177 dated Feb. 14, 2003.
- International Search Report from PCT Patent Application No. PCT US/2003/004378 dated Aug. 13, 2003.
- International Search Report from PCT Patent Application No. PCT/US2003/0033605 dated Mar. 29, 2004.
- International Search Report from PCT Patent Application No. PCT/US2003/033606 dated Mar. 29, 2004.
- International Search Report from PCT Patent Application No. PCT/US2003/004449 dated Aug. 13, 2003.
- International Search Report from PCT Patent Application No. PCT/US2004/006695 dated Sep. 8, 2004.
- International Search Report from PCT Patent Application No. PCT/US20004/033007 dated Feb. 9, 2005.
- International Search Report from PCT Patent Application No. PCT/US2005/014372 dated Jul. 28, 2005.
- International Search Report from PCT Patent Application No. PCT/US2006/019727 dated Apr. 19, 2007.
- International Search Report from PCT Patent Application No. PCT/US2006/038684 dated Feb. 14, 2007.
- International Search Report from PCT Patent Application No. PCT/US2007/019227 dated Feb. 20, 2008.
- International Search Report from PCT Patent Application No. PCT/US2007/019833 dated Feb. 20, 2008.
- International Search Report from PCT Patent Application No. PCT/US2007/019940 dated Mar. 14, 2008.
- International Search Report and Written Opinion for PCT application PCT/US2008/008726, dated Oct. 16, 2008.
- International Search Report of PCT Patent Application No. PCT/US2008/063440 dated Aug. 1, 2008.
- International Search Report for PCT application PCT/US2008/008729, dated Jul. 17, 2008.
- Felsher, et al., “Mucosal Apposition in Endoscopic Suturing”, Gastrointestinal Endoscopy, vol. 58, No. 6, pp. 867-870, (2003).
- Stecco, K. et al., “Trans-Oral Plication Formation and Gastric Implant Placement in a Canine Model”, Stecco Group, San Jose and Barosense, Inc., Redwood City, California (2004).
- Stecco, K. et al., “Safety of a Gastric Restrictive Implany in a Canine Model”, Stecco Group, San Jose and Barosense, Inc., Redwood City, California (2004).
Type: Grant
Filed: Sep 16, 2016
Date of Patent: Jan 21, 2020
Patent Publication Number: 20170000637
Assignee: Boston Scientific Scimed, Inc. (Maple Grove, MN)
Inventors: Samuel Crews (Palomar Park, CA), Bretton Swope (Gaithersburg, MD), Justen England (San Francisco, CA)
Primary Examiner: Dianne Dornbusch
Application Number: 15/267,520
International Classification: A61F 5/00 (20060101); A61B 17/00 (20060101); A61B 17/064 (20060101); A61B 17/128 (20060101);